Incomplete but useful? Professional responses to cost-containment constructs
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Date
2025
Authors
Malmi, Teemu
Derichs, David
Carr, Michelle
Journal Title
Journal ISSN
Volume Title
Publisher
John Wiley and Sons Inc
Published Version
Abstract
Adopting an institutional logics lens, this study examines how different professional groups interpret and respond to incompleteness during the development of an accounting construct in a U.S. teaching hospital. Using an interventionist research design, we co-developed the construct by integrating financial and clinical data to identify and reduce unwarranted cost variations. Drawing on 28 interviews conducted in winter 2018 and spring 2023, alongside field observations, our findings reveal distinct professional responses. Frontline clinicians recognized the construct's incompleteness but saw value in it as a discussion aid. Guided by a hybrid logic of professional autonomy and patient-centered care, they adopted a reflexive change response, selectively using the construct to enhance decision-making. Hospital managers, operating within a segmentation logic of performance and compliance, viewed incompleteness as a manageable limitation. Their pragmatic negotiation response balanced internal support for the construct with external reporting requirements. Clinician-managers, positioned between clinical and managerial logics, experienced tension when the construct failed to satisfy either. Reflecting a dominance logic where clinical concerns prevailed, they ultimately adopted an active resistance response. We contribute to accounting research by demonstrating how institutional logics shape the performative effects of accounting incompleteness. Although incompleteness is widely recognized as socially constructed and interpretively flexible, our study explains why professionals respond to the same incomplete construct in different ways. We show that institutional logics influence the performative capacity of accounting constructs by shaping how professionals interpret and respond to perceived incompleteness—either enabling uptake, redefining purpose, or undermining legitimacy—depending on how that incompleteness aligns with or challenges dominant logics.
Description
Keywords
Accounting incompleteness , Cost management , Healthcare accounting , Institutional logics , Interventionist research
Citation
Malmi, T., Derichs, D. and Carr, M. (2025) 'Incomplete but useful? Professional responses to cost‐containment constructs', Financial Accountability & Management. https://doi.org/10.1111/faam.70021